Cost and Value

Where does the true value of cancer treatment lie? Oncology experts grapple with this important question, with one of the more recent people to chime in being Robert C. Young, M.D., of RCY Medicine in Philadelphia, in an essay in a recent issue of the New England Journal of Medicine.

Dr. Young reviews several initiatives that seek to quantify value in various cancer treatments, acknowledging: “For people in our society who believe that cost should never be a consideration in decisions about the treatment of serious illnesses, these initiatives will be unsettling.” Yet the fact remains that the cost of cancer care is projected to rise from 2010’s $125 billion to $158 billion in 2020. In fact, some of the latest cancer medications now cost $10,000 to $30,000 per month. In addition, treatment based on a combination of checkpoint inhibitors rings in upwards of $100,000 per month.

Meanwhile, none of these medications provides an actual cancer cure and may not even extend survival time. The costs to patients can be staggering, with some patients unable to cover the cost and thus choosing to skip treatment altogether.

A key initiative to consider is an American Society of Clinical Oncology (ASCO) report published June 2015, in which they aimed to evaluate selected treatment regimens based on clinical benefit, toxicity, and cost. It’s an initiative they dub Value Framework. As one example, a newer three-drug combination for multiple myeloma was examined to determine its “net health benefit.” In this case, the net health benefit was deemed to justify the far higher cost compared to the previous standard treatment ($7,042 vs. $279). On the other hand, another case study suggested that the cost difference between new and old non-small-cell lung cancer treatments did not hold value to justify the price difference ($9,193 vs. $811).

Shining a brighter light on these issues is sure to help patients, physicians, and the health care system overall navigate the difficult path of determining value in treatment.